CBT And Muscles

[Elliot]

Hey guys, I was given a CBT booklet a while back from the university of Liverpool, essentially it explained that m.e/cfs is due to an onset of a virus or trauma, but then the body becomes weakened (so much to as short as five days it can start occuring). Which produces weakened muscles, which would explain the muscle pain. And then the weakened thigh muscles which are responsible for a lot of blood being pumped to the brain would cause the profound fatigue and cognitive impairment.

Is there actually any evidence based upon this? Sorry if this is in the wrong section or it has been posted before..but I'm just wondering what kind of science is behind what they are purporting.

 

[Gerwyn]

The thigh muscles may be involved in venous return and can be important for blood circualtion in the LEGS venous return is largely goverened by a system of one way valves in the legs . Problems with the heart,lungs' carotid stenosis and vasular sclerotisation in the arteries,capilaries and so on in brain can effect tissue oxygen levels. Assuming no peripheral vascular disease ,and a healthy heart ,the calf muscles would not effect the brain----the muscles bit is wrong too ischaemia would be the most likely cause of such pain with resulting low levels ofATP---sound familiar

There are lies damn lies and there is CBT the last refuge of the scientifically illiterate!

 

[thefreeprisoner]

It does sound like a plausible explanation, doesn't it? Almost had me...

However. (And bearing in mind science isn't my strong suit; I've had to figure all this stuff out through the brain fog, and may have grasped some bits incorrectly.)

What they are describing is basically 'orthostatic intolerance' - an inability to stand up for very long, due to the heart having trouble getting blood upstairs. That this could be caused by weak thigh muscles seems to me like nonsense.

If this were true then you would see gradual onset of fatigue as the muscle wasting got more pronounced. Which I know happens in some people.
BUT if you could get weakness this profound in only 5 days then surely there is something else severely wrong with your muscles? Most people for example get the flu and they lie in bed for 2 weeks and they're back to work. 2 weeks is nowhere NEAR enough for muscle wastage to even start.

A further comparison from my own personal experience: 2 years ago I tore the cartilage in my left knee. It took 3-4 weeks of resting up at home and gradually increasing the walking I did using crutches, for me to get better. According to this theory, I should be as weak as I am now after that much lounging around at home. However I was on the mend very quickly and the muscle pain was nothing like what I have now.

Recently due to ME I have been kept awake at night sometimes by the crampy-style pain in my calves or my sternum.
Then it was just a bit achy, like when you come home from a long shopping trip.
They are different sorts of pain with different causes.

Dr David Bell (as far as I remember) -- or was it Dr Cheney? somebody correct me -- says that muscle wastage only contributes 15% of the muscle pain and weakness seen in ME patients.

HTH
Rachel xx

 

[Esther12]

I'm still not sure on deconditioning - I think that they believe it would have to be combined with distorted thought processes, and such a combination would make it difficult to disprove. It seems that most of the psychological and behavioral explanations for CFS are now actively pursuing non-falsifiability.

With deconditioning - if you simply paced, maintaining a set level of activity - shouldn't the feelings of exhaustion at this level of activity dissipate? I've gone through periods of my life where I've done very little physical activity: vegging out over Christmas, when Mario 64 was first released, I've come down with the flu really badly a couple of times - being bed bound for a week - longer than when I had glandular fever; but it never resulted in any noticeable level of deconditioning. Surely they need an explanation as to why GET is either so ineffective, or else so difficult to do properly? - Because we're all so crazy we think it's not helping when really it is?

There often seems to be a real laziness to this sort of research - a disinterest in tying up the details because the theory fits so well with the prejudices of its proponents. I don't think it's impossible that some strange form of deconditioning takes place with CFS, but I've not found those arguing this to be the case to be terribly convincing so far.

 

[IamME]

According to this "logic" every single paraplegic in the world must have "profound fatigue and cognitive impairment" due to "weakened thigh muscles".

Of course it's pisswater of the highest order.

Honestly what do you expect from Peter Denton White and Wessely et al? It's politics, not science.

 

[Robin]

According to this "logic" every single paraplegic in the world must have "profound fatigue and cognitive impairment" due to "weakened thigh muscles".

Or people who had gone through major surgery. My brother had a colon resection which involved several days in the hospital and a long recovery. He even said to me "wow, I must feel like you do! I get tired from driving to the pharmacy!"

Within a month or so he was feeling much better. The OPs pamphlet is more applicable to that type of situation, not ME/CFS.

 

[CJB]

Deconditioning is real, but it disappears with exercise. I was severly ill when I was 19 and spent 4 weeks in the hospital. For three of those weeks, I was not able to get out of bed and had tubes everywhere.

My first trip out of bed, I made it to the chair beside the bed while the nurses changed the sheets. The next day I made it to the door of the room and back. The next day out into the hall, etc. Exercise cures deconditioning. I have "walked" my way out of three major abdominal surgeries and a car accident.

I had this chat with my doctor. I KNOW how to recover from a deconditioning problem. I've done it before. It doesn't work with CFS. Period. End of story.

 

[fds66]

I dont' understand how the deconditioning argument works when I have a bad day and can hardly walk at all and after resting up for a few days I can walk further - how can resting be helping deconditioning? I understand that it is better to keep moving to keep my body working but I really don't understand how deconditioning can come and go depending on how much the ME is flaring up.

 

[Gerwyn]

I dont' understand how the deconditioning argument works when I have a bad day and can hardly walk at all and after resting up for a few days I can walk further - how can resting be helping deconditioning? I understand that it is better to keep moving to keep my body working but I really don't understand how deconditioning can come and go depending on how much the ME is flaring up.

As IAMME said its pisswater otherwise known as total bollocks---I,m not even sure that they were talking about OS as this is an autonomic dysfuction and has a strong postural element------if they are talking OS and calf muscles then its even worse!

 

[usedtobeperkytina]

Yes, weakened muscles is part of the illness. But there can be many causes.

I notice what you quoted said body and muscles become weak, but it doesn't say directly what causes the weakness. I disagree that weak muscles cause OI. Flexible veins, stretchy connective tissue, a miscommunication between the HPA axis, heart and veins can cause pooling in the legs.

I can only speak to my experience. When I plummeted, within a few days, I not only had fatigue, but muscle weakness, to where I couldn't open jars of stuff in the kitchen that I used to be able to. I think the weakness comes with the fatigue or comes after the fatigue. The way they are describing it, the weakness comes first. That was not my experience.

I disagree with their conclusion.

Tina

 

[flybro]

My experience poops all over this theory.

I was working in a physically demanding job, there was no de-conditioning. Diziness, balance cogntive problems and weakness were the things that stopped me working. I carried on trying for 2/3 years.

Even when I no longer was able to work, I tried to regain my fitness levels by exercising when I could. I even got a wii and wii fit board. My physical abillities continued to decline, along with my cognitive abilities.

Now that I have learnt more about the disease, I have slowed the detoriation down considearably. Accepting my limitations and not trying to constantly achieve the next step has improved my cognitive rate of decline.

My physical abilities are more reliable, and I have had less fluey feverish symptoms.

I have less inflamation and 'touch wood', so far this year I have not spent one whole day in bed. I have been able to get up, washed and dressed more or less everyday.

I've recently experimented with low dose antibitoics which appered to have help. Shortly I hope to try low dose antibitics for at least 6 weeks.

For the first time since this disease started on me that I feel its not all win, win, win for the disease.

 

[Dolphin]

Wiborg et al (2010) recently reported on three Dutch studies where CBT interventions seemed to decrease fatigue levels and increase functional capacity (if you believed the questionnaire data) didn't involve increased activity levels as measured by actometers. People were still doing lower than normal levels of activity even though the CBT is "sold" in the Netherlands as potentially being curative

Friedberg has also found this with some studies he did where he encouraged people to walk as part of CBT - people weren't doing anymore at the end of it than at the start (so they were giving up activities to do the walk).

It doesn't look like CBT is achieving what it claims to do.

 

[PoetInSF]

And then the weakened thigh muscles which are responsible for a lot of blood being pumped to the brain would cause the profound fatigue and cognitive impairment.

Is there actually any evidence based upon this?

I'd be very much interested in reading about it too if anybody has a link to a paper. (It would be great if you can post your Liverpool pamplet also.)

When in crash after a muscular exertion, my thigh muscles are so weak and achy, I walk like a polio victim for days. Funny thing is, even upper body exertion results in achy thighs. The best relief I found is 30 min slow walk with minimal muscular exertion. It's as if it has something to do with thigh muscles and blood circulation, though not necessarily exactly the way you described it.

 

[Dolphin]

Orla (author of the first link in my .sig) and I both have copies of the Liverpool service literature. Orla has posted it on another forum before and I know hopes to post it here at some stage along with with a critique. Both I and Orla think it is very lame and in some cases contradictory. It is very hard-line - you shouldn't even lie down for rests as I recall as this can cause "chair-deconditioning" (a phrase I never heard of before this document). A lot of it is a series of reasons to try to get people to exercise.